Children’s Center Preschool Registration

Stafford Children’s Center is a state licensed developmental preschool program with a number of attributes including low child to teacher ratio, monthly field trips, plus nutritious meals and snacks. Available Monday-Friday 7:30 a.m. – 4:00 p.m.

Stafford Children's Center Admission Form

Child's Name
FirstLast
Date of Birth
Address
Street AddressAddress Line 2CityZip Code
Home Phone
Father's Cell Phone
Mother's Cell Phone
Father's Name
FirstLast
Father's Work
Mother's Name
FirstLast
Mother's Work
Emergency Contact
Name
FirstLast
Phone
Address
Street AddressCityZip Code
Relationship
Name
FirstLast
Phone
Address
Street AddressCityZip Code
Relationship
Please List People Authorized To Pick Up Your Child
Name
FirstLast
Relationship
Name
FirstLast
Relationship
Name
FirstLast
Relationship
Child Health Information
Doctor
Phone
Dentist
Phone
Does your child have allergies?
Is your child on medication?
Does your child have special needs?
Immunization
- Please check if "Yes"
I have provided my child’s immunization records and will send in updated copies as they occur. My child’s caregivers have permission to provide and secure emergency care in my absence including transportation to the area hospital until the time in which I can reach my child, I understand I will be contacted immediately if such care is needed. I have received a copy of the center handbook and agree to the conditions therein
Parent Signature
Date
Parent Signature
Date
Admission Date
Withdrawal Date

For more information call (802) 770-1033 or (802) 770-1042.

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Children’s Center Preschool Registration

Stafford Children's Center Admission Form

Emergency Contact

Please List People Authorized To Pick Up Your Child

Child Health Information